a medical librarian's adventures in evidence-based living

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Who needs avocados when you have fat-free Sahara Cuisine Roasted Red Pepper Hummus? We are loving Sahara Cuisine's Fat-Free Hummus & Black Bean Dips! It absolutely substitutes for the creamy mouth-feel of avocado on a sandwich or on a cracker. I don't even miss my beloved Terrapin Ridge Spicy Chipotle squeeze. Dump a can of chipotle's with adobo sauce into a blender--freeze for storage--and add a teaspoon to some red pepper hummus & you've got instant delicious chipotle sauce to top your sandwich or bean/veggie burgers. See below for where to buy hummus.

I was eating way too much sodium/salt and fat without even knowing it. Although I read labels carefully, I never paid much attention to the sodium content of vegetable broths, and soups. My favorite brand, Imagine, has oil & huge amounts of salt added to all their vegetable soups (like Tomato & Roasted Red Pepper, Cuban Black Bean Bisque, & Moroccan Chickpea Bisque). Like 750 mg ( 31% DV) of sodium for 1 cup of Tomato & Roasted Red Pepper Soup & who eats just 1 cup of soup? There's added oil in almost every store-bought pasta sauce, bread, tortilla wrap, veggie burger, cracker, or chip. It doesn't matter if it's organic, or from a "health food" company like Amy's, Gardenburger, or Whole Foods. Look at the labels. Who knew? Buy Pacific Low Sodium Vegetable Broth at 140 mg per cup, or Trader Joe's Low Sodium Vegetable Broth.

Unsweetened Regular Silk Soy Milk is an acceptable coffee creamer. It works. It lightens my coffee, and tastes just fine. We were used to buying cartons of Trader Joe's Soy Creamer, thinking the added sweetener & expeller pressed canola oil in it was OK. It was almost as bad as using Cremora powdered coffee lightener--well maybe not quite as bad.

Not missing the nuts! It's funny, I thought I couldn't live without nuts or Larabars. Don't miss them at all. Soon after ditching the nuts I got to see Jeff Novick's DVD on "From Oil To Nuts" (click here) that explains why nuts aren't exactly the health foods we think they are. They're high in calories, they all have some saturated fat, and except for English walnuts, all of them are very high in inflammatory omega-6s--especially pine nuts, peanuts, almonds, brazil nuts, and my favorite, cashews! I serendipitously found Dr. Bill Lands' NIH lecture about the importance of lowering our intake of omega-6 fats--and now I'm convinced about the benefits of no-oil & no nuts (walnuts excepted). Big tip: do yourself a favor & cut out peanut butter!! It's sky high in omega-6's. More on Bill Lands & Jeff Novick in another post--in the meantime if you'd like to catch Bill's lecture (you'll have to register with iAmplify & download the lecture), click here.

Knowing the rules of the game makes it easier to play the game. I don't even think about eating ice cream (vegan or dairy), chips of any kind, cookies, pretzels, or dark chocolate. They are just off my list. If I want a snack in the evening, it's watermelon, berries, a couple crackers with hummus, or maybe air-popped popcorn. It's as simple as that. We talk about how kids need boundaries--it makes life easier for them. I guess I do to!

100% Cheese-free Pizza can be a gourmet delight. What a treat for me! On Wednesday not only did I have to work while my kids were visiting from New York City (bummer), but I had a 3 1/2 hour long dental appointment afterward. When I got home at 7:30, my son (who is a fantastic cook) was ready to pop 3 cheese-free pizzas into the oven. He used 100% whole wheat Kabuli Pizza crusts (found at a non-Whole Foods natural food grocery) and Nature's Hilights Brown Rice Pizza Crust (found in the freezer section) of Whole Foods. He topped the crusts with a no-oil added pasta sauce, an assortment of vegetables we had just picked up from our Amish farmer's C.S.A. (community-supported agriculture co-op), and seasoned them with oregano, basil, and chives from my garden. Even my picky cheese-loving St. Louis son gave these pizzas a big thumbs-up--after first moaning & questioning the logic of cheese-free pizza. Tip: We preferred the Kabuli crust to the Hilight's.

Do not drink juice. Fruit is fine. A little juice used to saute, or season recipes or for salad dressings is fine

Do not eat nuts, even walnuts unless you do not have heart disease.

Do not eat avocados, if you have heart disease.

Do not eat coconut, if you have heart disease.

Eat soy products cautiously. They are high in fat (40% +) and many are highly processed. Only use Lite Tofu (like Mori-Nu or NaSoya Lite Firm Tofu). I also use Soy Boy Organic 5 Grain Low Fat Tempeh.

Reduce sugar as much as possible. When you do use it for recipes, stick to the more unprocessed varieties. But don't fool yourself, maple syrup, agave, and honey are still sugar. I use stevia.

Read all labels, especially THE INGREDIENTS!!!

The Rest of the World of Vegetables, Fruit, Legumes, and Whole Grains is Yours.

Read Labels Carefully--What to Watch Out For

1. Be sure no fat is added. Products change, and their ingredients change all the time. Make sure there is no added oil of any kind, in the ingredient list, even if the label says zero fat. By law products can contain less than .5% gram of fat & still say zero fat. Glycerin, hydrogenated or partially hydrogenated, mono and diglycerides are all forms of hidden fat. When you start carefully looking at labels you start to notice that there is added fat in EVERYTHING--even no-fat vegan Boca Burgers, and pasta sauces that say they have no fat.

3. Find a bread that's whole grain, and made without oil--another big challenge. Options include whole wheat pita, Ezekiel 4:9 breads, buns, wraps, & English Muffins. You'll find the Ezekiel/Food for Life brand at Whole Foods,Trader Joe's, and in the freezer case at most grocery stores. I love all their products--and they are flourless, and sprouted--which is supposedly healthier.

4. Find yourself a pasta sauce made without oil or too much salt.Options: Trader Joe's Organic Spaghetti Sauce with Mushrooms is oil-free, Whole Foods has a brand, as well as Muir Glen's Portobella Mushroom Sauce. Or make your own.

5. Veggie Burgers would be fine--but I can't find one brand that is made without oil. I make my own Lentil Dal Burgers, Falafel Burgers, and Smoky Tofu Red Bean Burgers & freeze them.

Ann's Amazing Cooking Tips

Ann has over 20 years of experience with eating & cooking no-oil & plant-based. This is just a few of her many tips.

1. Roast Vidalia onions, covered in a low to moderate oven & keep in the fridge to chop up for recipes. I made almost instant grilled onions to top burgers with one of these--just a 5 minute oil-free saute with paprika & a dash of pepper. Bingo!

2. Roast a supply of sweet potatoes or yams to add to salads, recipes, or to just enjoy plain.

4. Use no-fat added hummus as mayonnaise, as a sandwich base, an avocado substitute, a dip for veggies or crackers or pita, or a base for creamy salad dressings. It's amazing stuff!

5. Try to steam a few vegetables each night for dinner.

6. Use a wooden citrus reamer to get all the juice out of even dry limes or lemons--a microplane is a must for zesting citrus, or grating ginger. I wouldn't want to eat plant-based without my Kyocera ceramic utility knife!

7. Cook perfect collard greens in boiling water for a few minutes until slightly tender, and use them as wraps, or to make veggie sushi.

8. If you do just one thing, Eat Greens! Cook them along with your pasta water. Kale, collards, Swiss Chard, bok choy, etc. are the best foods you can eat--have them as often as you can--blend them in Green Smoothies, add them to soups, stir fries, or just sauteed with garlic & lemon.

12. Flavored balsamic vinegars are worth the price. Get these rich, flavorful vinegars from Olive Tap online, or through Dr. Joel Fuhrman's website.

13. Healthy desserts are OK once in awhile. Ann whips up lime & chocolate mousse with 1 package of Mori-Nu silken tofu, 1/3 cup maple syrup, then either 2 TBS. of cocoa powder or 3 TBS. of lime juice, depending on the version, and the zest of 1 lime for the lime version or 1 tsp. vanilla for the chocolate version. She refrigerates or freezes for 2 hrs. before serving. A blender or VitaMix works best. She likes to layer the lime mousse with berries. I've tried her recommendation of Sweet Nothing Non-Dairy Fudge Bars & loved them! She also gives an A-OK for an occasional Haagen-Dazs, Edy's, or Dole fruit sorbet. Read the labels.

Food Brands That I Recommend from Ann's Extensive List

Ann has put together an incredible list of recommended foods that meet her high standards.

This product is not widely available, but you can order it by the case, and it's not expensive. Ann says you can freeze them. Call the owner, Hassan Kahlid at 216-832-8833. Or get your health food store to carry them. Be sure to only order the no-fat, no tahini varieties.

Oasis Classic Cuisine Zero Fat Hummus. Comes no-fat in original, Mediterranean Medley, Roasted Red Pepper, Shiitake Mushroom only. I have not tasted these. Call the manager Evan Lanigan at 419-269-1459 for local locations, or to order a case.

Trader Joe's Mango Salsa

Trader Joe's Pineapple Salsa

Trader Joe's Corn and Chili Tomato-Less Salsa (this isn't on Ann's list, and sugar is the #2 ingredient) but 2 Tbs. on top of a salad is a fantastic spicy sweet ingredient. I love this mixed into brown rice, black beans, & mango salsa.

Broth

Pacific Organic fat-free vegetable broth LOW SODIUM. This is the lowest in sodium brand Ann has found at 140 mg/cup.

After just under 2 weeks I'm happily surprised to notice that I've lost about 2.5 pounds (most people lose much much more, however)--but this is very unusual for me, because my weight just seems to stay stable, and believe me, I'm eating a lot!

My blood pressure is now consistently in the healthy range, even after weight-lifting. Before, it was often variable. I'm assuming this is because I'm eating much less sodium.

Not jumping to any conclusions here, but I'm just not tired at anytime during the day (except yesterday when I only got about 5 hours of sleep)--and I'm not ready for bed until about an hour later than usual.

I'm not feeling the sudden hunger pangs that I felt last week. I owe that to eating a hearty breakfast, and a giant salad that includes some seitan, soba noodles, or an Ezekiel English muffin. I makes sure I stay fueled.

Stay Tuned for more updates--and the experiences of some of Dr. Esselstyn's patients.

Oops! I replied to Linda 2 days ago, and never got around to "publishing" my own reply! Hope this helps to explain.

Linda,

I appreciate your concern, but it's unfounded. This diet makes certain that you get adequate omega-3s. N-3s are in tofu, beans, green leafy vegetables, flax meal, & chia seed, berries & English walnuts. If one were to eat a diet of 1750 calories, and 9-12 servings vegetables, beans, fruit, & flax they'd get more than enough of all their omega-3s. And since omega-3s have to compete with omega-6s for absorption into our cells, if the n-6s are too high (as in the typical American diet with a ratio of 17:1), the n-3s are just crowded out. Ideal ratio should be 1:1, or 2:1. N-6's are inflammatory, and too many are disease-causing.

All experts agree that it's better & easier to just lower one's intake of the n-6s (found in oils, margarine, meats, chicken, processed foods, peanuts, & most nuts), than try to fix the ratio by ingesting more n-3s.

You aren't going to increase your n-3s by ingesting oils. As for me, not only do I eat flax meal and chia--I also take pharmaceutical grade omega-3 fish oil & a DHA supplement (which isn't something Dr. Esselstyn would advise, however)

One important note: the diet isn't no-fat--it's no added fats. Fat exists naturally in most foods--especially in oats & soy.

Follow the link in the post to Bill Lands' NIH lecture--and watch the Jeff Novick video. Also, Dr. E has been using this diet successfully since the mid-80's. It's how he & his family eat. His patients are alive, healthy, thriving, and disease-free.

Double Rainbow is not a Trader Joe's Brand. But that may be the easiest place to find it outside the San Francisco Bay Area. Local health food stores may also carry it, as may small independent groceries.

Thanks for your post about Dr Caldwell Esselsty's heart health diet, and for all your posts, I love reading them and have picked up some great tips. I don't think I can kiss goodbye to avocados yet though.

As far as I know, I don't have heart disease--but he suggested that I give it a 3 week trial without walnuts (also OK without heart disease) or avocados, (or oil of any kind, including when I eat out), and see how I feel, and how the numbers check out. Three weeks is flying by, and so far I'm shocked to miss any of it!

I love your blog! You write, "a microplane is a must for zesting citrus, or grating ginger. I wouldn't want to eat plant-based without my Kyocera ceramic utility knife." If I can ask, what model you have and how do you use it?

Gack. must toss the peanut butter.
And even walnuts aren't good, they've got far more Omega-6 than Omega-3, according to the same video.

Could I balance about a tablespoonful of peanut butter and a glob of something full of omega-3s (fish oil capsules) to overwhelm the omega-6s?
Nope. Got to get the total fat down to half a percent of the diet, before the different mix of omega-3s and omega-6s is in the range at which they get metabolized in useful ways, if I understand this.

Heck, the oil in the vitamin-D and fish oil supplements is already more than that.

Quotes hand typed from the audio with reference to the caption scrolling text:

"the two types ... are metabolized by the same enzymes ... you can't make them on their own ... knowing what the proportion is ... will prove to be a valuable marker of tissue status....
... All you really need to know is what's the percent of omega-3 and omega-6 .... I like to talk about the problem in the tissue is the percent of omega-6 that's there, and when you don't have a lot of omega-6 there you don't have a lot of problems ....
... when you eat a little bit [of omega-3 or omega-6]... you get this tremendous linear increase .... but as you get up around 1 percent of daily calories it levels off .... and then the system's saturated and no more change. That is the beginning of enzyme kinetics for you guys ...."
AHA -- with dietary intake for the average person up above 10 percent, a small change in dietary intake isn't going to make a difference -- the kinetics say you have to cut the amount of this stuff down into the range below 1 percent before the kinetics curve starts changing

"whether it's omega-6 or omega-3, that's what supply does."
And
"what about in the context of omega-6 competition? .... and as you have more and more omega-6 the omega-3 is not very effective .... there are a lot of articles in the literature .... all done in the presence of substantial excesses of omega-6 ....the reality in the United States is you're way up here ... the rest of the world has another reality .... the paradoxes of a hyperbolic saturable system .... Sheila Innis showed us that if you lower the linolete .... in 2003 or 2006 she published .... everything is actually rational, predictable and real but you've got to deal with the numbers .... the midpoints for linoleic and linolinic .... we can tell what diet will do to tissue, I have it in a spreadsheet .... I want you to interact with that spreadsheet .... the midpoint for 50 percent removal of an excess of omega-6 .... is done with less than a half percent of daily calories. The median status .... in the United States is 100x the requirement or 10x the daily allowance...."

per the video...

I wish the images on the video were actually legible, but at least it's captioned with the text of what he's saying.

http://journal.shouxi.net/qikan/article.php?id=351962
"Conclusions: With caveats inherent for ecologic, nutrient disappearance analyses, a healthy dietary allowance for nC3 LCFAs for current US diets was estimated at 3.5 g/d for a 2000-kcal diet. This allowance for nC3 LCFAs can likely be reduced to one-tenth of that amount by consuming fewer nC6 fats."

Then it gets confusing:http://www.umm.edu/altmed/articles/omega-6-000317.htm
"There are several different types of omega-6 fatty acids, and not all promote inflammation. Most omega-6 fatty acids in the diet come from vegetable oils as linoleic acid (LA). Be careful not to confuse this with alpha-linolenic acid (ALA), an omega-3 fatty acid. Linoleic acid is converted to gamma-linolenic acid (GLA) in the body. It is then further broken down to arachidonic acid (AA). GLA can be gotten from several plant-based oils including evening primrose oil (EPO), borage oil, and black currant seed oil.

Gamma-linolenic acid (GLA) may actually reduce inflammation. Much of the GLA taken as a supplement is converted to a substance called DGLA that fights inflammation...."

http://www.springerlink.com/content/l5r4h54485616443/
" Conjugated linoleic acid supplementation in humans have been shown to cause insulin resistance and fatty liver. Because of lack of any significant health benefit from CLA consumption and its associated risks on insulin resistance and fatty liver, this natural or synthetic group of fatty acids cannot be recommended as a supplement that can be used to improve human health."
(CLA sources are: meat, milk, and partially hydrogenated vegetable oils)

(that's cited in a footnote to this large paywalled article you may have access to as a librarian: http://www3.interscience.wiley.com/journal/123200352/abstract
Molecular Nutrition & Food Research
Volume 54 Issue 2, Pages 175 - 185
Special Issue: Special: Novel Approaches for Risk Assessment of Phytochemicals in Food, Published Online: 3 Dec 2009

Journal of the American College of Nutrition, Vol. 18, No. 5, 487-489 (1999)
Workshop on the Essentiality of and Recommended Dietary Intakes for Omega-6 and Omega-3 Fatty Acids

"First, the amount of plant oils rich in LA, the parent compound of the omega-6 class, which is converted to AA, needs to be reduced. Second, simultaneously the omega-3 PUFAs need to be increased in the diet. LA can be converted to arachidonic acid and the enzyme, {Delta}-6 desaturase, necessary to desaturate it, is the same one necessary to desaturate LNA, the parent compound of the omega-3 class; each competes with the other for this desaturase. The presence of LNA in the diet can inhibit the conversion of the large amounts of LA in the diets of Western industrialized countries which contain too much dietary plant oils rich in omega-6 PUFAs (e.g. corn, safflower, and soybean oils). The increase of LNA, together with EPA and DHA, and reduction of vegetable oils with high LA content, are necessary to achieve a healthier diet in these countries...."

The broader recommendation for using low-does aspirin has recently been limited to those who've already had heart attacks because of GI bleeding problems. I wonder how differently aspirin affects people with surplus omega-3; I'd guess all the studies done on US citizens are on average people with excess omega-6. Citing papers:http://jem.rupress.org/cgi/crossref-forward-links/196/8/1025

You do need the slides Dr. Land was showing. Anyone know if they're available in better form?

This is the full day's program in one video: http://videocast.nih.gov/summary.asp?live=8108
"Air date: Wednesday, October 14, 2009, 8:00:00 ... You can drag the timer button slightly to the right to the 12 minute mark where Dr. Lands begins speaking."

(The video quality is a little better though many of the slides are still illegible)

He mentions two recent papers, mentioned in notes handed out at that meeting (can we get them??):

"A critique of paradoxes in current advice on dietary lipids." Progress in Lipids Research (2008) ("The editor ... let me have unlimited space and unlimited references, a luxury. So invite you to read this because it illustrates what are the primary causes that are readily modifiable and can be prevented ...")

"... dietary fish oil is required for the production of omega-3-rich farmed fish and this commodity, in a vicious circle, is at present derived solely from wild fisheries.... This review attempts to compile all principal information available regarding the effects of fish oil replacement for the diets of farmed finfish .... the production, availability and main nutritional characteristics of fish oil and the principal alternative lipid sources (such as vegetable oils and animal fats)."

Just wanted to let you know, HL, my 15yo saw the pic of your vegetable bin lunch while he was peeking over my shoulder and said, "That looks really good!" So now I really do have to get that red lentil recipe going on since there is no Trader Joe's in this state! Nor can I find seitan in the Kroger or the local health food store. Sigh. But blackberries we have a plenty, for free.

Last bit, summarizing, by Dr. Land:
"... this puts together everything I've told you. And I want you to see.... to get you to where you really would like to be. Let's lower the omega-6. You're eating like 17,000 milligrams a day. What would happen if you just made it 4,000? ([video timestamp] 47:21) Now you're at a level ... where you now have the protection that you want. You can prevent it. It's as simple as that. You can get this from the website NIH.gov...."

I come from a long line of heart disease, just turned 61, have had HIGH LDL for 25 years... and want to change.

I wonder about the elimination of fish and all oils - I've read so much about how the brain NEEDS these to be healthy. Does anyone know any research on long-term effects of removal of all oils and fish on brain health? Also, being totally new to all this - should I continue to take low-dose aspirin? Vitamins? B-complex? And can anyone recommend a good protein powder - I'm assuming you need some source of protein and I'm not a fan of eggs...

Sorry for all the questions but it's hard to read every blog and website just to find these specific answers. You guys seem to be a great source of information on vegan diet and heart health!
Thanks so much! Christin

Wow, Chris, quite a a lot of questions! I personally take a high quality molecularly distilled fish oil, and I also take a vegetarian form of DHA. Dr. Esselstyn would not recommend one eat fish or take a fish oil supplement, for many excellent reasons.

"What about fish or fish oil capsules? Don't we need our omega 3's?

Fish oil isn't a panacea and it can raise total and LDL cholesterol levels, increase your chance for hemorrhagic stroke, and suppress your immune system. If the fish oil is rancid it releases disease-causing free radicals. Better to rely on ground flaxseed meal, walnuts, soybeans, and green leafy vegetables. There are vegetarian forms of omega 3's, like the all important DHA (a must for pregnant women, babies & brains)--click here for more info. And bottom line: Where do the fish get their omega 3's? From feeding off of plankton--microscopic plants."

Research is inconclusive right now about whether short-chain omega-3s (ALAs) can convert to provide sufficient omega-3s--necessary for brain health. I'm hedging my bets. Fish oil, in the long run isn't sustainable--and eventually, omega-3s should be more widely available in algal-format.

Can't answer about low-dose aspirin. As for B vitamins (my opinion only) it's better to get them from whole food sources, and they're plentiful in beans, greens, & citrus. If you're eating vegetarian you will definitely need a B12 supplements, and Dr. Esselstyn advises 1000 mcg a day--that seems like a lot, but as we age we absorb less & less. You don't want to short-change yourself on B12. Best to take it sub-lingually, to bypass the digestive system.

As for protein powder, most of us get more than we need--not a good thing. If you exercise a lot, and feel you need more, avoid isolated soy protein or whey protein. Neither are recommended--and have cancer-causing implications.

My husband uses a rice protein that works quite well--but he is a high level exerciser. Others use hemp protein. Eat lots of beans--high in protein, too. Hope this helps!

I've been following Esselstyn's whole plant diet for 7 months with great results. Cholesterol below 150 and lost 10 lbs in the first 2 weeks. They recommend eating greens at every meal. I often make "stews" with some type of whole grain and a myriad of veggies, but making a salad to boot...too much work!! All I do is shop, schlep and cook. I found that I really like to get my Kale in with a smoothie, but have heard that Esselstyn doesn't approve because h e believes that one is better sated when eating the greens and also the greens turn into glucose too quickly??? Could you shed some light on this.

I'm not worried about weight as I weigh less now than I did when I was 12 years old. I'm 5'9" tall and weigh 118. I've been trying to find some definitive info on drinking your greens as smoothies to no avail.
Thanks in advance.

Thank you so much for your wonderful blog! I just saw "Forks Over Knives" and it really impacted me...

I was hoping to ask a quick question: You mentioned in this post that Ann Esselstyn had an extensive food list -- could you tell me how I can find it? Or is it contained in the book "Prevent and Reverse Heart Disease"?